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European Heart Journal Advance Access originally published online on January 16, 2007
European Heart Journal 2007 28(13):1660; doi:10.1093/eurheartj/ehl465
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

A left atrial thrombus too big to embolize

Patrizio Lancellotti*, Marc Radermecker and Luc A. Piérard

Department of Cardiology and Cardiovascular Surgery, University Hospital Sart Tilman, B-4000 Liege, Belgium

* Corresponding author. Tel: +32 4 366 71 94; fax: +32 4 366 71 95. E-mail address: plancellotti{at}chu.ulg.ac.be

A 72-year-old woman with rheumatic mitral valve stenosis was admitted to the hospital after an episode of syncope. She had no prior history of stroke. She was in atrial fibrillation since several months and received oral anticoagulation. At the time of admission, the international normalized ratio was low (1.15), indicating inadequate anticoagulation. Neurological examination was normal. A transthoracic echocardiogram confirmed the presence of severe mitral valve stenosis, with a mitral valve area of 0.5 cm2, and showed a big highly mobile free-floating left atrial thrombus, which caused intermittent occlusion of the mitral valve (panels A–D and video clip). Such an unattached, freely moving clot in the left atrium is called a left atrial ball thrombus. The patient was submitted to surgical mitral valve replacement. The examination of the left atrium showed a giant free thrombus (T, panels E–G) and a severe mitral valve (MV) stenosis. She made an uneventful recovery and was doing well a few months later.

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This Article
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Right arrow All Versions of this Article:
28/13/1660    most recent
ehl465v1
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